Laserfiche WebLink
Cb <br /> Effective Date: 10-ly1av-99 11 <br /> Revision: 1 Numbcr 3 of <br /> Nenatne: f=:�QC.Forins''.QC Cooler.�k,pd <br /> COOLER RECEIPT CHECKLIST <br /> - Login#: i LW ZST i)ate R,1ceived:_(x123- as---- 'I umber of Coolers: _Z) F- <br /> Client: t eS 'r <br /> GfLEWEQ Il�;ect: _R SD_ 'TaN-------- ---_--- <br /> A. Preliminary Examination Phase it <br /> Date Opened:6 3 0o By (print): -TIZE (sign) .�.�.•.i�s --�, <br /> —� <br /> 1. Did cooler come with a shipping slip (airbill, etc.??...--'..................................... N0 <br /> If YES, enter carrier name and airbill num[er: _F_P_LS> <br /> ?. Were custody seals on outside of cooler?.............:.......!,................................... YES 'Q] <br /> How many and where? Seal date: !I. Seal name: <br /> 3. Were custody seals unbroken and intact at the date and time of arrival?...........ter;^"r � <br /> 4. Were custody papers dry and intact when received"....'?............ (ED NO ' <br /> 5. Were custody papers filled out properly (ink, signed. e.t'c.)?.............................. -N <br /> b. Did you sign the custody papers in the appropriate place?................................ Z�) NO i <br /> 7. Was project identifiable from custody papers"................................................. NO <br /> If YES, enter project name at the top of this form. :Ji 1 <br /> $. If required, was sufficient ic_ used? Samples should be.2-6 degrees C. ............ YES 4±) ; <br /> Type of ice: w&7T- Temperature:._ c C ' <br /> B. Login Phase <br /> Date Logged In:6123100 By (print): .Z (sign) 1/�i1 �•w..J -� <br /> 1. Describe type of packing in cooler: <br /> 2. Did all battles arrive unbroken?.....................................�i........................—...... <br /> NO <br /> 3. Were labels in good condition and complete (lr�, date, [ime, signature, etc.)?... E NO <br /> 4. Did bottle labels agree with custody papers'................. .................................. NO <br /> 3 a <br /> 5. Were appropriate containers used for the tests indicated?................................. ES � "O <br /> . 6. Were correct preservatives added to samples?...............?.................................. O <br /> 7 . Was sufficient amount of sample sent for tests indicated?................................. S '�f0 <br /> E 8. Were bubbles absent in VOA samples? If NO, list sample Ids below................. ' 1 N_ <br /> C <br /> 9. Was the client contacted concerning this sample delivery?................................ YES Q 'O_ <br /> If YES, give details below. <br /> Who was called? By whom"I <br /> f <br />{ Additional Comments: <br /> j� <br /> FAename: F:%gclformslcoaler.wpd --- ;, Rev. _.--- _-_ <br />